Answers to Your Questions About Panic Disorder

Panic Disorder is a serious condition that around one out of every 75 people
might experience. It usually appears during the teens or early adulthood, and
while the exact causes are unclear, there does seem to be a connection with
major life transitions that are potentially stressful: graduating from college,
getting married, having a first child, and so on. There is also some evidence
for a genetic predisposition; if a family member has suffered from panic
disorder, you have an increased risk of suffering from it yourself, especially
during a time in your life that is particularly stressful.

A panic attack is a sudden surge of overwhelming fear that comes without
warning and without any obvious reason. It is far more intense than the feeling
of being "stressed out" that most people experience. Symptoms of a panic attack
include:

raging heartbeat

difficulty breathing, feeling as though you "can't get enough air"

terror that is almost paralyzing

dizziness, lightheadedness or nausea

trembling, sweating, shaking

choking, chest pains

hot flashes, or sudden chills

tingling in fingers or toes ("pins and needles")

fear that you're going to go crazy or are about to die

You probably recognize this as the classic "flight or fight" response that
human beings experience when we are in a situation of danger. But during a panic
attack, these symptoms seem to rise from out of nowhere. They occur in seemingly
harmless situations--they can even happen while you are asleep.

In addition to the above symptoms, a panic attack is marked by the following
conditions:

it occurs suddenly, without any warning and without any way to stop it.

the level of fear is way out of proportion to the actual situation; often,
in fact, it's completely unrelated.

it passes in a few minutes; the body cannot sustain the "fight or flight"
response for longer than that. However, repeated attacks can continue to
recur for hours.

A panic attack is not dangerous, but it can be terrifying, largely because it
feels "crazy" and "out of control." Panic disorder is frightening because of the
panic attacks associated with it, and also because it often leads to other
complications such as phobias, depression,
substance abuse, medical complications, even suicide. Its effects can range from
mild word or social impairment to a total inability to face the outside world.

In fact, the phobias that people with panic disorder develop do not come from
fears of actual objects or events, but rather from fear of having another
attack. In these cases, people will avoid certain objects or situations because
they fear that these things will trigger another attack.

Please remember that only a licensed therapist can diagnose a panic disorder.
There are certain signs you may already be aware of, though.

One study found that people sometimes see 10 or more doctors before being
properly diagnosed, and that only one out of four people with the disorder
receive the treatment they need. That's why it's important to know what the
symptoms are, and to make sure you get the right help.

Many people experience occasional panic attacks, and if you have had one or
two such attacks, there probably isn't any reason to worry. The key symptom of
panic disorder is the persistent fear of having future panic attacks. If you
suffer from repeated (four or more) panic attacks, and especially if you have
had a panic attack and are in continued fear of having another, these are signs
that you should consider finding a mental health professional who specializes in
panic or anxiety disorders.

Body: There may be a genetic predisposition to anxiety disorders; some
sufferers report that a family member has or had a panic disorder or some other
emotional disorder such as depression. Studies
with twins have confirmed the possibility of "genetic inheritance" of the
disorder.

Panic Disorder could also be due to a biological malfunction, although a
specific biological marker has yet to be identified.

All ethnic groups are vulnerable to panic disorder. For unknown reasons,
women are twice as likely to get the disorder as men.

Mind: Stressful life events can trigger panic disorders. One
association that has been noted is that of a recent loss or separation. Some
researchers liken the "life stressor" to a thermostat; that is, when stresses
lower your resistance, the underlying physical predisposition kicks in and
triggers an attack.

Both: Physical and psychological causes of panic disorder work
together. Although initially attacks may come out of the blue, eventually the
sufferer may actually help bring them on by responding to physical symptoms of
an attack.

For example, if a person with panic disorder experiences a racing heartbeat
caused by drinking coffee, exercising, or taking a certain medication, they
might interpret this as a symptom of an attack and, because of their anxiety,
actually bring on the attack. On the other hand, coffee, exercise, and certain
medications sometimes do, in fact, cause panic attacks. One of the most
frustrating things for the panic sufferer is never knowing how to isolate the
different triggers of an attack. That's why the right therapy for panic disorder
focuses on all aspects -- physical, psychological, and physiological -- of the
disorder.

Panic disorder is highly treatable, with a variety of available therapies.
These treatments are extremely effective, and most people who have successfully
completed treatment can continue to experience situational avoidance or anxiety,
and further treatment might be necessary in those cases. Once treated, panic
disorder doesn't lead to any permanent complications.

The immediate danger with panic disorder is that it can often lead to a
phobia. That's because once you've suffered a panic attack, you may start to
avoid situations like the one you were in when the attack occurred.

Many people with panic disorder show "situational avoidance" associated with
their panic attacks. For example, you might have an attack while driving, and
start to avoid driving until you develop an actual phobia towards it. In worst
case scenarios, people with panic disorder develop agoraphobia -- fear of going
outdoors -- because they believe that by staying inside, they can avoid all
situations that might provoke an attack, or where they might not be able to get
help. The fear of an attack is so debilitating, they prefer to spend their lives
locked inside their homes.

Even if you don't develop these extreme phobias, your quality of life can be
severely damaged by untreated panic disorder. A recent study showed that people
who suffer from panic disorder:

are more prone to alcohol and other drug abuse

have greater risk of attempting suicide

spend more time in hospital emergency rooms

spend less time on hobbies, sports and other satisfying activities

tend to be financially dependent on others

report feeling emotionally and physically less healthy than non-sufferers.

are afraid of driving more than a few miles away from home

Panic disorders can also have economic effects. For example, a recent study
cited the case of a woman who gave up a $40,000 a year job that required travel
for one close to home that only paid $14,000 a year. Other sufferers have
reported losing their jobs and having to rely on public assistance or family
members.

None of this needs to happen. Panic disorder can be treated successfully, and
sufferers can go on to lead full and satisfying lives.

Most specialists agree that a combination of cognitive and behavioral
therapies are the best treatment for panic disorder. Medication might also be
appropriate in some cases.

The first part of therapy is largely informational; many people are greatly
helped by simply understanding exactly what panic disorder is, and how many
others suffer from it. Many people who suffer from panic disorder are worried
that their panic attacks mean they're "going crazy" or that the panic might
induce a heart attack. "Cognitive restructuring" (changing one's way of
thinking) helps people replace those thoughts with more realistic, positive ways
of viewing the attacks.

Cognitive therapy can help the patient identify possible triggers for the
attacks. The trigger in an individual case could be something like a thought, a
situation, or something as subtle as a slight change in heartbeat. Once the
patient understands that the panic attack is separate and independent of the
trigger, that trigger begins to lose some of its power to induce an attack.

The behavioral components of the therapy can consist of what one group of
clinicians has termed "interceptive exposure." This is similar to the systematic
desensitization used to cure phobias, but what it focuses on is exposure to he
actual physical sensations that someone experiences during a panic attack.

People with panic disorder are more afraid of the actual attack than they are
of specific objects or events; for instance, their "fear of flying" is not that
the planes will crash but that they will have a panic attack in a place, like a
plane, where they can't get to help. Others won't drink coffee or go to an
overheated room because they're afraid that these might trigger the physical
symptoms of a panic attack.

Interceptive exposure can help them go through the symptoms of an attack
(elevated heart rate, hot flashes, sweating, and so on) in a controlled setting,
and teach them that these symptoms need not develop into a full-blown attack.
Behavioral therapy is also used to deal with the situational avoidance
associated with panic attacks. One very effective treatment for phobias is in
vivo exposure, which is in its simplest terms means breaking a fearful situation
down into small manageable steps and doing them one at a time until the most
difficult level is mastered.

Relaxation techniques can further help someone "flow through" an attack.
These techniques include breathing retraining and positive visualization. Some
experts have found that people with panic disorder tend to have slightly higher
than average breathing rates, learning to slow this can help someone deal with a
panic attack and can also prevent future attacks.

In some cases, medications may also be needed. Anti-anxiety medications may
be prescribed, as well as antidepressants, and sometimes even heart medications
(such as beta blockers) that are used to control irregular heartbeats.

Finally, a support group with others who suffer from panic disorder can be
very helpful to some people. It can't take the place of therapy, but it can be a
useful adjunct.

If you suffer from panic disorder, these therapies can help you. But you
can't do them on your own; all of these treatments must be outlined and
prescribed by a psychologist or psychiatrist.

Much of the success of treatment depends on your willingness to carefully
follow the outlined treatment plan. This is often multifaceted, and it won't
work overnight, but if you stick with it, you should start to have noticeable
improvement within about 10 to 20 weekly sessions. If you continue to follow the
program, within one year you will notice a tremendous improvement.

If you are suffering from panic disorder, you should be able to find help in
your area. You need to find a licensed psychologist or other mental health
professional who specializes in panic or anxiety disorders. There may even be a
clinic nearby that specializes in these disorders.

When you speak with a therapist, specify that you think you have panic
disorder, and ask about his or her experience treating this disorder.

Keep in mind, though, that panic disorder, like any other emotional disorder,
isn't something you can either diagnose or cure by yourself. An experience
clinical psychologist or psychiatrist is the most qualified person to make this
diagnosis, just as he or she is the most qualified to treat this disorder.

This brochure is designed to answer your basic questions about panic
disorder; a qualified mental health professional will be able to give you more
complete information.

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